Tag Archives: PHR

Do You Really Believe That 41% Of People Would Switch Physicians To Gain Online Access To Their EMR?

I love survey data as much as the next person. But some of the survey data finding its way into the health care press these days is pure baloney…which is good if you like baloney.

Such was the case with the finding from an Accenture study which was making the rounds of the Health Information Technology (HIT) Journals, HIT Blogs and Twitter feeds during National Health IT Week. You will no doubt recall the headlines which proclaimed that “41% of U.S. consumers would be willing to switch physicians to gain online access to their own EMRs.”

Upon first glance, the question of “would you be willing to switch physicians” to accomplish a social good (access to your electronic medical records) seems reasonable enough. It’s one of those questions that most of us would be inclined to agree with. It’s kind of like asking people if they would be willing to pay lower taxes or pay less to fill up your car’s gas tank. Of course we will say yes.

In the Accenture study literally everyone did! Remember 36% of respondents said they already had full access to their EMR (whatever full access means), 27% said they had limited EMR access and 37% said they did not yet have any EMR access. So if 41% said they would switch physicians to get EMR access we are left to conclude that all 100% of those without EMR access would switch…plus 4% of those who already had EMR access would also switch doctors presumably because they wanted more EMR access.

At face value, this Accenture data does not hold water…and here are a couple of reasons why.

  • 79% of people (patients) are already very satisfied with their personal physician (patients who rated their physician 9-10 on the 10 point 2012 CHAPS survey released recently by AHRQ. Very satisfied patients are not likely to switch physicians unless they have a darn good reason and access to Health IT is not a good enough reason for most people.
  • People’s criteria for selecting a new physician focus on human interaction skills and clinical competencies – not the physician’s Reasons For Changing Doctorsuse of EMRs and other Health IT (i.e., PHRs, web portals, etc.).
  • Similarly, people’s reasons for switching physicians have to do with changes in insurance, relocation, and the physician’s human interaction skills…not the lack of an EMR, PHR or patient portal.
  • 100% of people can’t agree on anything including EMRs – intuitively we know that seniors (who have the highest health care need/use) have a higher trust in their physicians and are less inclined to care one way or another about Health IT, other people worry about personal data security and so on.
  • A 2012 survey by the Markle Foundation found that “79 percent or more of the public believe using an online PHR would provide major benefits to individuals in managing their health and health care services.” Yet actual consumer adoption of online PHRs has been less than 10% for the last several years (with some notable exceptions like Kaiser, Group Health and the VA). There’s a big difference between what people believe or say they are willing to do…and what they actually do.

The Take Away

What people actually do or intend to do (behavioral intentions) are much stronger and reliable predictors of behavior (switching physicians for example) than attitudinal questions about their beliefs or potential willingness to do something in the future in relation to other behaviors they could engage in. The Accenture study would have been more instructive had it asked respondents to rate the importance of Health IT (EMR) in relation to other physician selection factors like the physician interpersonal skills, their knowledge and experience, etc. It would also be helpful for Accenture to inquire as to the respondent’s knowledge of EMRs and what constituted full versus limited access…and which is addresses the consumer’s level of interest and need.

3 First Principles For Evaluating Patient-Facing HIT Solutions

With the HIMSS13 Conference next week we can expect to hear a lot about how health information technology (HIT) and e-Health is expected to challenge and change the way health care now and in years to come.  To be sure great strides have been made in the adoption of electronic medical records, decision support, and patient web portals… with the promise of more to come.  Health Apps, in spite of their painfully slow uptake by many consumers, press forward with innovative new toimagesols.

Yet in order to realize the full promise of patient-facing like EMRs, PHRs, patient portals and the like, we need to be more mindful of the following “first principles.”

First Principles #1 – Health care delivery and healing occurs in the context of interpersonal relationships.

Today, as in the past, health care is delivered within the context of interpersonal relationships, e.g., the physician-patient relationship.  Sir William Osler, the father of modern medicine, recognized this along with the importance of a clinician’s communication skills when he said “listen to the patient and they will tell you what is wrong.”   Today, as in Osler’s time, encouraging patients to “tell their story” is the hallmark of good communication skills.  Eliciting the patient’s story is also a hallmark of strong healing relationships…since the simple act of “talking” and “feeling heard” have been shown to have clear therapeutic benefits.

The same is true with the intensely interpersonal act of “laying on of hands.”  “Touch” as a method of healing dates back to biblical times and beyond.   Today, physicians like Abraham Verghese, MD continue to speak to about therapeutic value of touch as practiced during patient exams in both the hospital and ambulatory settings.  These same physicians caution us against losing sight of the central role and value of the physician-patient relationship in the false belief that technology will one day be capable of replacing the personal physician.

First Principles #2 – HIT cannot compensate for weak physician-patient relationships or poor physician-patient communication skills.   

We hear today about how primary care physicians are very busy…and getting even busier.  EMR systems, e-visits, decision support tools, patient portals and the like are touted as solutions for saving time, increasing quality, etc.  While all this may be true, a great EMR system or secure e-mail visits cannot turn a physician with sub-optimal patient communication skills into a patient-centered Marcus Welby, MD.  It will probably make things worse.

Absent strong, physician-patient relationships and equally strong patient-centered communication skills, such HIT investments are like building castles upon sand.

Another hallmark of patient-centered communication is a “meeting of the minds” between patients and their physicians regarding issues like the visit agenda, the accuracy and severity of the diagnosis and which treatment options will work best.  Unfortunately since many physicians today continue to employ a physician-directed style of communicating with patients…the patient’s perspective is seldom sought…and a meeting of the minds never has a chance to occur.   Even if EMRs accommodated the patient’s perspective, the clinician first has to ask the patient…and that just isn’t happening.

 First Principles #3 – Beware of unintended consequences

Many HIT professionals will quickly dismiss the above first principles cited above in the name of improving physician productivity.  After all, given today’s shortage of primary care physicians we have no choice but to layer on more HIT like EMRS and self-help patient portals.  But as with anything, one needs to be prepared for the consequences.  And there are always consequences.

In addition to improving productivity, health care professionals cite patient engagement as yet another reason to invest in HIT.  But is that really the case?

We have all seen the research citing how patients would “like” secure e-mail with their doctor, online appointment scheduling, access to their doctor’s notes, etc.   Who in their right mind would not like this?  But liking is not the same as using.  Of perhaps more importance is the finding that the vast majority of patients (85%) want to know that they will still have the ability to see their doctor face-to-face when needed after they have access to the above conveniences .   People aren’t dumb.  We/they know that technology is increasingly getting in between us/them and our/their physician.  Provider organizations that try and channel patients into substituting web portals and PHRs for physician office visits run the risk of pushing patients/members into the waiting arms of their competitors.

A recent study of decision support tools underscores yet another unintended consequence – loss of trust in their physician.  Interestingly, certain patients saw the use of computer decision support tools as a reflection of their physician’s clinical knowledge.   That is, physicians that used decision support tools were perceived as being less knowledgeable than physicians that didn’t employ them.  Since clinical skills are a driver of patient trust, the risk of encouraging physicians to “engage” patients by using decision support tools is that you may well be disengaging them by increasing their distrust.

So What’s The Take Away?

We need to recognize that there are fundamental first principles concerning the delivery of healing and health care.  To that extent that HIT professionals and those that write the checks for HIT understand these principles one has a better chance of meeting their expectations.

Here are three questions that need to be considered when evaluating any patient-facing HIT solution:

  1. Does technology support or detract from the physician-patient relationship in a meaningful way?
  2. Does the technology presuppose the presence of strong physician-patient relations and physician-patient communication skills?
    Do you even know what kind of patient communication skills your physicians have?
  3. What are the potential unintended consequences of adopting the proposed technology?

That’s what I think…what’s your opinion?

Sources

Agarwa, R. et al.   If We Offer it, Will They Accept? Factors Affecting Patient Use Intentions of Personal Health Records and Secure Messaging.    Journal of Medical Internet Research 2013;15(2):e43.

What Are Your Personal Health Goals? Have You Ever Shared Them With Your Doctor? Has Your Doctor Ever Asked You What Yours Are?

Face it.  We all have personal health goals.  We may not share our personal health goals with family of friends like we do our financial or professional goals, but we all still have them.   I for example aspire to the following personal health goals:

  • To defy the conventional wisdom associated with aging (look younger, feel younger, live like I am younger).
  • To avoid premature aging – vision problems, flexibility and balance issues, aging and appearance, weight gain, skin tone, etc.
  • To not be called old by my grand kids
  • To live a more active life than my parents did
  • Question authority (yes I am a product of the 60’s and 70’s)

OK personal health goalsso I am vain.  I bet I am not the only one.  I am just the one dumb enough to publicly admit it (LOL).

Have I ever share these goals with my doctor?  Are you kidding me?

He can’t deal with the fact that I experience depression from time to time and insist on telling him about it…eeewww.   Besides…he will just tell me that getting old is part of the natural process.   You are supposed to lose your hearing, lose your balance and flexibility, get fat and wrinkly, become senile, and so on.   Let’s face it. It’s hard to have a conversation with someone – including your physician – when you know from experience that they are simply not interested  in what you have to say…or don’t share your point of view…when it comes to certain subjects.

There’s also another reason I have never shared my person health goals with my physician.   I have never been asked.

In their defense, doctors aren’t trained to care about things beyond the realm of strict biomedical conditions – acute conditions in other words.   That’s why it is so hard for physicians and many other provider types to get their heads around patient-centered care.   To become more patient-centered providers need to deal with touchy feely issues like personal health goals, personal health beliefs and motivations, family issues, depression, anxiety and all the other human emotions.   A physician I know referred to patient-centered care as a kind of “rabbit hole” physicians just don’t want to go down.  Getting to know the “person behind the disease” is time consuming and can take you down paths you not sure where they end up!

Health care executives, providers and payers wonder why patients aren’t more engaged in their health…aka do as they are told.  The problem isn’t that patients (people) aren’t engaged in their health…they are…the problem is that so much of what is passed off as patient engagement these days (EHRs, PHRs, team care, care coordinators, web portals, decision support tools) are not inherently engaging to us patients!   Why?  Go back and read my personal health goals and explain to how today’s technology-enabled vision of patient engagement is at all relevant to my (and I suspect many of your) personal health care goals.   

That’s what I think.   What’s your opinion?

Post Script

As I mentioned in my last post, I am heading up a research team that will be auditing 2,500 physician-patient conversations recorded during primary care office visits from across the US.   Among the many questions we will seek to answer will be the frequency with which physicians and/or patients raise the question of the patient’s personal health goals.

Stay tuned.  For more information on the 2012 Physician-Patient Communication Benchmark Report click here.